Healthcare Provider Details

I. General information

NPI: 1144855214
Provider Name (Legal Business Name): ALYSSA CIRUCCI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SAGEMORE DR STE 10101
MARLTON NJ
08053-3944
US

IV. Provider business mailing address

10000 SAGEMORE DR STE 10101
MARLTON NJ
08053-3944
US

V. Phone/Fax

Practice location:
  • Phone: 856-452-8586
  • Fax:
Mailing address:
  • Phone: 856-596-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MP00623500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: